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Perspectives on Psychological Science Perspectives on Psychological Science http://pps.sagepub.com/ How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective Britta K. Hölzel, Sara W. Lazar, Tim Gard, Zev Schuman-Olivier, David R. Vago and Ulrich Ott Perspectives on Psychological Science 2011 6: 537 DOI: 10.1177/1745691611419671 The online version of this article can be found at: http://pps.sagepub.com/content/6/6/537 Published by: http://www.sagepublications.com On behalf of: Association For Psychological Science Additional services and information for Perspectives on Psychological Science can be found at: Email Alerts: http://pps.sagepub.com/cgi/alerts Subscriptions: http://pps.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Downloaded from pps.sagepub.com at The University of Iowa Libraries on May 24, 2012 Perspectives on Psychological Science 6(6) 537 –559 How Does Mindfulness Meditation Work? © The Author(s) 2011 Reprints and permission: sagepub.com/journalsPermissions.nav Proposing Mechanisms of Action From a DOI: 10.1177/1745691611419671 Conceptual and Neural Perspective http://pps.sagepub.com Britta K. Hölzel1,2, Sara W. Lazar2, Tim Gard1,2, Zev Schuman-Olivier2, David R. Vago3, and Ulrich Ott1 1Bender Institute of Neuroimaging, Justus Liebig-University, Giessen, Germany; 2Massachusetts General Hospital, Harvard Medical School, Boston, MA; and 3Brigham and Women’s Hospital, Harvard Medical School, Boston, MA Abstract Cultivation of mindfulness, the nonjudgmental awareness of experiences in the present moment, produces beneficial effects on well-being and ameliorates psychiatric and stress-related symptoms. Mindfulness meditation has therefore increasingly been incorporated into psychotherapeutic interventions. Although the number of publications in the field has sharply increased over the last two decades, there is a paucity of theoretical reviews that integrate the existing literature into a comprehensive theoretical framework. In this article, we explore several components through which mindfulness meditation exerts its effects: (a) attention regulation, (b) body awareness, (c) emotion regulation (including reappraisal and exposure, extinction, and reconsolidation), and (d) change in perspective on the self. Recent empirical research, including practitioners’ self-reports and experimental data, provides evidence supporting these mechanisms. Functional and structural neuroimaging studies have begun to explore the neuroscientific processes underlying these components. Evidence suggests that mindfulness practice is associated with neuroplastic changes in the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network, and default mode network structures. The authors suggest that the mechanisms described here work synergistically, establishing a process of enhanced self-regulation. Differentiating between these components seems useful to guide future basic research and to specifically target areas of development in the treatment of psychological disorders. Keywords anxiety disorders, attention, cognition, consciousness, neuroscience, positive psychology, stress disorders Mindfulness meditation has been reported to produce beneficial treatment of disorders and improvement of health; it has also effects on a number of psychiatric, functional somatic, and been shown to produce positive effects on psychological well- stress-related symptoms and has therefore increasingly been being in healthy participants (Carmody & Baer, 2008; Chiesa & incorporated into psychotherapeutic programs (cf., Baer, 2003; Serretti, 2009) and to enhance cognitive functioning (Jha, Grossman, Niemann, Schmidt, & Walach, 2004). A large body Krompinger, & Baime, 2007; Ortner, Kilner, & Zelazo, 2007; of research documents the efficacy of mindfulness-based inter- Pagnoni & Cekic, 2007; Slagter et al., 2007). Historically, mind- ventions in the treatment of a number of clinical disorders, fulness is a concept stemming from ancient Buddhist philoso- including anxiety (Hofmann, Sawyer, Witt, & Oh, 2010; phy (Bhikkhu, 2010), and is practiced to achieve enduring Roemer, Orsillo, & Salters-Pedneault, 2008), depression (Hof- happiness (Ekman, Davidson, Ricard, & Wallace, 2005) and to mann et al., 2010; Teasdale et al., 2000), substance abuse gain insight into a view of the true nature of existence (Olen- (Bowen et al., 2006), eating disorders (Tapper et al., 2009), and dzki, 2010). chronic pain (Grossman, Tiefenthaler-Gilmer, Raysz, & Kesper, 2007). Furthermore, mindfulness meditation positively influ- ences aspects of physical health, including improved immune function (Carlson, Speca, Faris, & Patel, 2007; Davidson et al., 2003), reduced blood pressure and cortisol levels (Carlson et al., Corresponding Author: 1 Britta K. Hölzel, Bender Institute of Neuroimaging, Justus Liebig-University, 2007), and increased telomerase activity (Jacobs et al., 2010). Otto-Behaghel-Str. 10 H, 35394 Giessen, Germany Not only has mindfulness successfully been used in the E-mail: [email protected] Downloaded from pps.sagepub.com at The University of Iowa Libraries on May 24, 2012 538 Hölzel et al. Table 1. Previous Theoretical Accounts That Describe Mechanisms of Mindfulness Meditation Publication Suggested components Shapiro, Carlson, Astin, and Freedman (2006) Attention, intention, attitude Brown, Ryan, and Creswell (2007) Insight, exposure, nonattachment, enhanced mind–body functioning, integrated functioning Baer (2003) Exposure, cognitive change, self-management, relaxation, acceptance Five Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Observing, describing, acting with awareness, nonjudging of inner Krietemeyer, & Toney, 2006) experience, nonreactivity to inner experience Definition of Mindfulness including (a) insight, (b) exposure, (c) nonattachment, (d) enhanced mind–body functioning, and (e) integrated function- In current research contexts, mindfulness is typically defined ing. Similarly, in her 2003 review, Ruth Baer summarized sev- as nonjudgmental attention to experiences in the present eral mechanisms that may explain how mindfulness skills can moment (Kabat-Zinn, 1990). Bishop et al. (2004) suggest a lead to symptom reduction and behavior change, namely (a) two-component model of mindfulness, where the first compo- exposure, (b) cognitive change, (c) self-management, (d) nent is the regulation of attention in order to maintain it on the relaxation, and (e) acceptance. A valuable empirical account immediate experience, and the second component involves for the description of the facets of mindfulness is the Five approaching one’s experiences with an orientation of curiosity, Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Kri- openness, and acceptance, regardless of their valence and etemeyer, & Toney, 2006), which was developed based on an desirability. Mindfulness is typically cultivated in formal med- item pool of previously existing mindfulness questionnaires. itation practices, such as sitting meditation, walking medita- Factor analyses over these items yielded five facets of mind- tion, or mindful movements (Kabat-Zinn, 1990). The practice fulness: observing (attending to or noticing internal and exter- of mindfulness meditation encompasses focusing attention on nal stimuli, such as sensations, emotions, cognitions, sights, the experience of thoughts, emotions, and body sensations, sounds, and smells); describing (noting or mentally labeling simply observing them as they arise and pass away. these stimuli with words); acting with awareness (attending to one’s current actions, as opposed to behaving automatically or absentmindedly); nonjudging of inner experience (refraining Need for a Theoretical Framework from evaluation of one’s sensations, cognitions, and emo- It is striking that this seemingly simplistic practice can have tions); and nonreactivity to inner experience (allowing such a wide range of applications and effects. Along with the thoughts and feelings to come and go, without attention get- many positive implications of mindfulness arises the question: ting caught in them). How does mindfulness work; what are its mechanisms? The field has produced a number of studies utilizing psycho- Although there is currently a large body of literature, covering logical scales or behavioral tasks that provide empirical support a wide range of research, including qualitative research, feasi- for some of the proposed components. Simultaneously, a grow- bility trials, controlled clinical trials, behavioral studies, and ing body of neuroimaging literature begins to describe brain neuroscientific research, there is a relative paucity of theoreti- activity during the meditative state as well as changes in neural cal reviews that consolidate the existing literature into a com- structure and function associated with meditation practice. To prehensive theoretical framework. our knowledge, no one has previously tried to consolidate the Existing research on mindfulness includes a few theoretical existing empirical literature. Our goal is to consolidate existing accounts describing mechanisms of mindfulness meditation findings and address several components that have been empiri- (see Table 1). Several of these accounts expound on the central cally supported. Furthermore, whereas the previous models role of attention in meditation practice (Brown & Ryan, 2003; have described the process of mindfulness almost exclusively
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